"We have the joy of seeing the difference we can make not just to a childs quality of life, and how they see life, but to their education and their prospects "
Rebecca Smart orthoptist above left
National Eye Health Week ends - today. The work goes on for specialist medics. And no matter the day, week, month or year, they need the rest of us to get the message.
Three leading local orthoptists have three wishes.
The first – that parents bring their children into clinic for follow up if the screening programme of four- and five-year olds across Lancashire recommends such. Problems can be remedied BEFORE a child’s vision system fully develops at around seven or eight.
The second – that parents get their children’s eyes tested, at any age, as a routine, not a reaction. Tests are free for the under-16s.
The third – that all stroke victims, of any age, are visually screened to reduce risks of being readmitted.
Orthoptists deal with how the eyes work together – two eyes being better than one.
This time last year Entirely Health racked up 19.8k hits with an article featuring the pilot programme set up in April to screen all reception age youngsters right across the county. An allied article added a further 17.8k readers.
We're not out to beat that total but build on the awareness raised.
Orthoptists at Blackpool Teaching Hospitals Foundation Trust led the way.
And they have come such a long way since.
One great lesson learned is that children previously thought ‘naughty’ may have a vision problem frustrating inter-action with others.
As it’s their ‘normal’ they don’t realise it- or can’t communicate it at four or five years old.
“We have the joy of seeing the difference we can make not just to a child’s quality of life, and how they see life, but to their education and their prospects” says orthoptist Rebecca Smart who joined Orthoptics at Blackpool Victoria Hospital in January 2017.
“I came here for my work experience and was hooked after two days with the orthoptics team, it encouraged me to apply for the degree course.”
Rebecca is Vision Screening Lead for Blackpool as part of Lancashire’s Vision Screening Service.
She’s responsible for the training of vision screeners, auditing the service and working directly with schools to get a screening schedule in place across the academic year.
“We have screened for the first time in 180 schools, over 5000 children aged four and five in reception, and we are screening in public and private schools.
“We also offer screening to home-schooled children; we contact parents by post asking them to contact the department and then invite them to a clinic. There’s one in Preston, one in Lancaster, and several within Fylde and Wyre.
“We work with hard to reach communities too."
Fellow orthoptist Ammarah Patel stresses importance of eye testing after reception age. “We have raised awareness that reduced vision impacts on children’s education and development in school. We need parents to keep up the good work.
“Children are very good at getting by without admitting they may have a vision problem. In their world, at their age, it’s their normal. If it’s affecting just one eye, their good eye masks the problem. But they won’t follow at the same pace of others. We pick that up.”
Ammarah joined Blackpool Teaching Hospitals in May 2018, and now supports the Lancashire Screening Service, works with ophthalmologists and optometrists at the hospital’s paediatric and adult orthoptic clinics and runs a paediatric orthoptic clinic at Cleveleys Group Practice.
She explains: “Orthoptists are specialists in how the two eyes work together, how they are balanced. The screening service for reception age children is crucial. When we go on the road, we pick up lazy eye, double vision, squint, so much more – and do something about it.
“We follow up children with really reduced vision and get them into clinic – some just need glasses and also need to WEAR those glasses; their vision improves, you see how far they come. These days frames of glasses are great.
“We need parents’ support, for them to come to appointments, read information about glasses, treatment and implement it all. They must not worry about what to expect or what the outcome will be, we support them through it.
“We want their children to have the best opportunities in life.”
Cath Jukes joined Blackpool Teaching Hospital after graduating from Liverpool University 22 years ago and is now the advanced orthoptist specialist in adult care, stroke, thyroid and neuro-ophthalmology.
More people are having strokes – at a younger age too - and referrals to orthoptists have increased.
Cath echoes her professional body’s wish – the British and Irish Orthoptics Society wants ALL stroke patients visually screened.
Cath explains: “It’s important due to the high incidence of visual problems. We screen for visual problems as 60 per cent have been found to have visual problems, 56 per cent impaired vision, 40 per cent eye movement problems, 28 per cent visual field loss, 27 per cent inattention, five per cent visual perception problems.
“Many are unaware or unable to articulate they have visual problems. When a problem is detected clear information can be given to the multi-disciplinary team - this is important for planning rehabilitation.
“A letter is also given to the patient, families and GP with detailed information as well as a named contact. Follow up visits and onward referrals to ophthalmology/ N-Vision (the local sight loss support charity) are arranged as needed. Clear advice is given regarding driving. We are very proud of the service we offer in Blackpool. As the manager of this service, I am always looking for ways to improve it.”
A stroke can impair central or peripheral vision or eye movement. It can cause visual field loss, double or blurry or reduced vision or how information is processed, hazards perceived, objects and people recognised, steps or depth or movement judged. It can also lead to Charles Bonnet Syndrome which produces silent hallucinations.
Cath trains doctors, physiotherapists, occupational therapists and the early discharge support team to screen for signs – and refer patients to orthoptics.
Referrals are crucial in rehabilitation, follow ups, and help prevent any issues that might otherwise arise after discharge from the stroke ward – which could lead to readmissions.
Locally, patients wait around a day and a half on average from referral to visual screening on ward. Ages range from 33 to 96, the average age being 74, for females, 68 for males.
Cath says: “We screen people on the stroke ward. It is a secondary referral system so anyone on the multi-disciplinary team can refer to us, doctors, physios, OTs, the early supported discharge team.
“If they have concerns, they check to see if there’s a visual field problem or anything else and then we do a full visual screen. If we pick anything up, I see them as outpatients as well, following them up every three to six months.
“The teams trying to get patients back into the community need to know whether there is a problem that may affect rehabilitation or hinder their recovery.
“Quite a lot with a visual field problem as a result of stroke have hemianopia – loss of one half of their visual field.
“If that’s not picked up, they will have problems with daily life, banging into things constantly on one side, a higher risk of falls so they could be readmitted, struggling to read – and more.
“We provide specific information and advice on what they can do to cope such as de-clutter the house, get rid of obstacles and hazards on the side affected, make barriers with defined, bolder contrasting outlines, learn every few seconds to look around to that side – like having a blind spot as a driver.
“I follow them up, they have my contact details. In the early stages, being in hospital, feeling unwell, dealing with so much associated with stroke, it can be hard to take in. I take the letter and try to talk to the family while they are there, too.
“Some 26 per cent get completely better, and 52 per cent partially improve. It’s similar for double vision, a good percentage of people do improve which is why we continue to follow them up.”
Cath praises the work of Elaine Day, the pioneering stroke programme lead for Healthier Lancashire and South Cumbria, who is passionate about improving all of stroke services within the region, determined to ensure the patient gets the right care, at the right time, in the right place, by the right people and that all patients receive the same quality and level of care no matter where they live.
Cath adds: “It’s a learning process for all. Communication has improved, we have a shared data base and can see whether patients have passed the early supported discharge assessment – and mine.”
Cath sees around eight people a week on average on the stroke ward and the same number in follow ups at the clinic. “Ideally we’d double the number of times we go on ward to screen everyone. It’s lovely when you do a follow up and some people have improved and are over the moon.”
The orthoptist favours compulsory eye testing for all motorists over 70. “A lot of people driving around really shouldn’t be - it’s not uncommon for me to come across people who have never had an eye test, their vision is really quite poor, and they have been driving for years. Or those who have glasses but don’t wear them.”
Cath had eye problems as a child. “My own problem was a squint, I had to get very strong glasses to prevent me walking into things. I wear contacts today.
“It gives you an insight and a passion for this work and the NHS. The work is rewarding, there’s quite a lot of autonomy, you get to know people as you treat them – and we don’t give up on them.
“My message for national eye health week is look after your health, look after your eyes, stop or least reduce smoking, see an optometrist every year or two at least, because your general health shows up in your eyes, there are lots of conditions which can be picked up and treated, earlier the better because you can start losing vision before becoming aware of it, and what you may perceive as a gradual deterioration can be quite significant.”
• For information and leaflets about stroke, vision screening as well as lots of other aspects of orthoptics - https://www.bfwh.nhs.uk/our-services/hospital-services/orthoptic-department/ For info on local sight loss support charity N-Vision covering Blackpool Fylde and Wyre see https://nvision-nw.co.uk/